COVID-19's Rude Interruption of Normalcy

"I think we should be having these conversations calmly and rationally now as opposed to waiting until it happens, and I want to emphasize if it happens."
"The [health] system is likely to be overwhelmed and that's why I think we need to get more aggressive with this now while we have time."
"We may dodge a big bullet here. This may be all about not very much, and that would be fantastic. But we may well end up in a situation where we have to make some very tough ethical decisions about who gets the ventilator."
"But at this stage, to the best of my knowledge, there is no consensus or even substantial discussion of [ventilator access criteria] in Canada. Not in the context of, 'do I put this patient or that patient on t he ventilator' We've never really had to be in that kind of situation. We do make decisions that we shouldn't offer ventilation."
"But this kind of triage where  you have to pick somebody who might have a better chance of benefiting from the treatment, those aren't scenarios that anybody has experience with and frankly that anybody wants to have any experience with."
"But in the case that we do end up with an Italian-type scenario, I think we would be well served to consider these issues in advance and engage members of the public to the extent possible."
"It's awfully difficult, if it comes to that, for the public to have faith in criteria that are developed if the public has had no input into their development."
Dr.Anand Kumar, critical-care doctor, Winnipeg Health Sciences Centre

A general view of the emergency centre of North York General Hospital on Monday, March 2, 2020. The government's priority now is to slow down the potential flood of serious infections that could far outstrip the health system’s capacity if left unchecked.  Tijana Martin/The Globe and Mail

The Canadian health care system is bracing itself, in anticipation of four to five weeks ahead when they could conceivably be in the grips of the same kind of grim moral choices that doctors in Italy are facing, where only COVID-19 patients with the greatest likelihood of survival and those with the most years of life before them are given access to scarce intensive care beds and ventilators. Canada needs to prepare for such a potential divisive and frightening possibility warn health experts.

According to modelling, ICUs may very well collapse with the strain of a dramatic rise in COVID-19 cases overwhelming the management capabilities of doctors struggling with inadequate numbers of ventilators and associated medical equipment to meet the challenge of this global pandemic raging through the world. While as yet the country is not facing the overwhelming numbers that have placed Italy in such desperate straits, all indications for the present are that Canada will likely face a similar situation.

Canada's hospitals are counting their ventilators, used to assist breathing in critically ill patients. Experts warn that Canadian hospitals have limited space and capacity. That's why slowing the spread of COVID-19 is important to preserve that capacity. (Craig Chivers/CBC)

Beside the critical shortage of equipment there is the concern over whether enough experienced ICU nurses and respiratory technicians will be available to manage a deluge of patients with viral pneumonia. What of a shortage of oxygen tanks; without oxygen people will become more critically ill. An assessment of ICU capacity saw 3,170 ICU beds and 4,981 ventilators. In other words, ten ICU beds capable of providing mechanical ventilation per 100,000 population and 15 invasive mechanical ventilators which places Canada above the U.K. but well below the U.S., Germany and Belgium.

None of this is lost to the public which strains to become familiar with all the latest news of the novel coronavirus that has so swiftly upended normal life in the country. A DART & marit/Blue poll most recently undertaken indicates that the majority of Canadians -- 82 percent -- have changed their behaviour resulting from the incursion of the virus. A full 65 percent of Canadians in February hadn't seen a need to alter their behaviour. The poll reveals that 52 percent of Canadians are worried they might contract the COVID-19 virus.

Close to 600 Canadians have now been diagnosed with the virus that has caused eight deaths thus far. Concerns among Canadians have escalated; 32 percent were concerned they might become affected back on March 1st. However, since governments across the country in recent weeks have announced major measures to contain the outbreak, public concern has risen markedly. The mood of the the vast majority -- 87 percent -- remains calm; asked how they feel, only 11 percent admit to feeling anxious, while two percent are "panicked".

The cleaning products aisle at a No Frills in Toronto (Photograph by Cole Burston)

Canadians who have a university education and women are among the most concerned at 58 and 55 percent respectively while those who are "completely panicked" are the people who have raided grocery store shelves, stocking up on toilet paper and meat and frozen vegetables, representing 5 percent of the population. A whopping 82 percent of Canadians have made and continue to make changes in lifestyle including hand washing (71 percent); avoiding public places like restaurants (39 percent); cancelling travel plans (23 percent) and avoiding the use of public transit (14 percent).

"In fact every habit measured over the last month in two previous polls has witnessed an  unprecedented engagement by the Canadian public to actively change various habits in their life or lifestyle", the poll concludes. How can it possibly be otherwise when the potential for real harm to themselves, those they love, or are their neighbours and friends appears so imminent leaving people to face such an uncertain short-term future?

Photograph by Cole Burston

"Absolutely now is the time to be having those discussions -and not waiting until] we have a bunch of exhausted and over-worked intensivists."
"What Italy is forced to do is something they thought was unimaginable in a high-income country."
"I'm hoping we don't have to, but we should at least be prepared for that and start to ask those very, very difficult questions."
Dr.Andrew Morris, infectious diseases specialist, Sinai Health System, University Health Network, Toronto

A pedestrian wears a protective mask as she walks in the winter weather downtown in Toronto. The novel coronavirus is expected to turn into a global pandemic. (Nathan Denette/The Canadian Press)